Non-invasive, Zip Type Skin Closure Device vs. Conventional Staples in Total Knee Arthroplasty: Which Method Holds Greater Potential for Bundled Payments?

Introduction: A new, noninvasive zip surgical skin closure device has recently been introduced into the market and introduces a new alternative to the traditional staple closure method which has dominated the industry for many years. Methods: This was a retrospective chart review and case study of a consecutive series of 130 patients who underwent primary total knee arthroplasty (TKA) from April 2016 to November 2016. The first 65 patients in this series underwent a primary TKA utilizing the standard staple closure method (staple group). The next 65 patients underwent a primary TKA through the new zip surgical skin closure method (zip group). Charts were reviewed for incision-related phone calls to the clinic, additional clinic visits due to incision concerns, antibiotic prescriptions due to incision complications, and incision-related emergency room (ER) admits. Results: The staple group had a significantly higher amount of incision-related phone calls made to the clinic as compared to the zip group (20 versus 8, P < .05, respectively). The staple group also had more incision-related ER admits, more incision-related clinic visits, and more antibiotics prescribed due to incisional complications than the zip group (1 versus 0, 5 versus 2, and 4 versus 1, respectively), although it was not proven to be significant (P > .05). Conclusion: This is the largest patient cohort study comparing the noninvasive zip-type closure device to staple closures in TKA cases and provides insight on how a simple change in the closure methodology can lead to many potential downstream savings when considering a bundled payment model.